{include file="header.html"}
<div class="page-header">
	<h6>
		<a href="?app=service&act=province">参保省市</a>
		<small>
			<i class="ace-icon fa fa-angle-double-right"></i>
			<a href="?app=service&act=city&province_id={$province_id}">参保城市</a>
			<i class="ace-icon fa fa-angle-double-right"></i>
			{$city_name}
			<i class="ace-icon fa fa-angle-double-right"></i>
			编辑类型
		</small>
	</h6>
</div>
<div class="row">
<div class="col-xs-12">
	<form class="form-horizontal" role="form" method="post" action="?app=service&act=casy_edit" enctype="multipart/form-data">
		<input type="hidden" name="id" id="id" value="{$row->id}" />
		<input type="hidden" name="province_id" id="province_id" value="{$province_id}" />
		<input type="hidden" name="service_city_id" id="service_city_id" value="{$service_city_id}" />
		
		<div class="form-group">
			<label class="col-sm-2 control-label no-padding-right" for="name"> 名称 </label>
			<div class="col-sm-10">
				<input type="text" name="name" id="name" value="{$row->name}" class="col-sm-3" />
			</div>
		</div>
		<div class="form-group">
			<label class="col-sm-2 control-label no-padding-right" for="money"> 最低基数 </label>
			<div class="col-sm-10">
				<input type="text" name="money" id="money" value="{$row->money}" class="col-sm-3" />
			</div>
		</div>

		<div class="clearfix form-actions">
			<div class="col-md-offset-3 col-md-9">
				<button class="btn btn-info" type="submit">
					<i class="ace-icon fa fa-check bigger-110"></i>
					提交
				</button>

				&nbsp; &nbsp; &nbsp;
				<button class="btn" type="reset">
					<i class="ace-icon fa fa-undo bigger-110"></i>
					重置
				</button>
			</div>
		</div>
	</form>
</div>
</div>
<script>
$(function(){
	
});
</script>
{include file="footer.html"}